Monday, 6 August 2007

Tackle the twin problem of iodine-iron deficiency


Syed Akbar
As the Centre gears up for a nation-wide ban on non-iodised salt from Independence Day, nutrition experts warn that unless the twin problem of iodine and iron deficiency is tackled simultaneously, a vast section of population, particularly women and students, will continue to be at high health risk.
The Central government's decision, though belated, is welcome but it will solve only half of the major health problem facing the country. The Centre seems to be looking at only one side of the health coin when it presses for universal iodised salt. The problem of iron deficiency demands equal attention, if not more. A small change in government's outlook will bring a sea change in the health scenario of the country. It should popularise double fortified salt, containing both iron and iodine.
Thanks to pioneering research by Hyderabad-based National Institute of Nutrition, both iodine and iron deficiencies can now be tackled by use of single dose of common salt. According to rough estimates, 300 million people suffer from iron deficiency as compared to 170 million people with iodine-related problems.
"Double fortified salt is good for people suffering from both iron and iodine deficiencies. In Andhra Pradesh many people, particularly women and children suffer from iron deficiency related problems. NIN's salt helps in both ways. The double fortified salt may cost a little more and the Centre may subsidise it through PDS", says NIN deputy director KVR Sarma.
Health records show that about 10 per cent of the population in rural Andhra Pradesh suffer from iodine deficiency while a whopping 40 per cent from low iron (haemoglobin) content in blood. What is worse is that whenever a fresh survey is conducted in the country, it exposes newer pockets. Official figures put the number of people with iodine deficiency at around 17 crore including 22 lakh people with goitre due to malfunction of thyroid gland.
It was also the National Institute of Nutrition that successfully fortified iodine with common salt. The NIN's method is a low cost approach to control the problem, since salt is used universally in the country in food items. Iodised salt is safe as there is no change in organoleptic properties of foods. Double fortification with iron is also found to be safe.
Noted dietician Sunita Sapur says salt with iron and iodine is an "excellent idea" to contain common health problems in women and children. Deficiency of iron and iodine is quite common in the country, both in urban and rural areas.
The Central government's decision to reimpose ban on non-iodised salt follows a five-year-long study by the National Institute of Nutrition that no State or union territory in the country is free from iodine deficiency. The latest survey carried out in 40 select districts revealed that people in 21 districts are endemic to health problems and diseases caused by iodine deficiency. Even people living near sea coast are also consuming less iodine.
Ban on non-iodised salt was imposed in the country in 1997 but the Centre lifted it in 2000. Andhra Pradesh and Maharashtra went in for partial ban while other States preferred a complete ban on non-fortified salt. Last year, Supreme court held that State governments could not impose ban on non-iodised salt on a permanent basis and this forced the Centre to plan for a nation-wide prohibition on salt without iodine content.
Under pressure from dieticians and nutrition experts the Andhra Pradesh government now decided to encourage salt farmers to set up facilities for mixing of iodine. Assistant salt commissioner AK Sharma points out that the government has mooted the idea to discontinue sale of salt without iodine as people in many areas in the State are prone to goitre. "Pregnant women and children are badly hit due to iodine deficiency. We will train salt farmers in modern techniques to boost iodised salt production in the State", he said.
Consultant endocrinologist Ravi Mehrotra argues that if iodine is not taken in sufficient quantities it will cause permanent damage to foetus and retard mental growth in later part of life. Iron in salt will an added advantage to solve the problem of anaemia along with goitre.
Several studies in Andhra Pradesh showed that 55 per cent of people consumed iodised salt with less than 5 ppm, although the percentage of population consuming salt with 15 ppm and more iodine was only 18.5 per cent. The National Family and Health Survey-II revealed that 27.4% of population consumed salt with 15 ppm of iodine. People in the coastal districts of Nellore (80 per cent), Visakhapatnam (76 per cent) and Prakasam (83 per cent) were consuming salt with less than 5 ppm of iodine.
The NIN study noted that India's population consumes salt with some amount of iodine, but only 49 percent uses adequately iodised salt. This figure fell to 37 percent after the lifting of the ban on non-iodised salt.
The State government estimates that nutritional deficiency among school aged children include iron deficiency (10.4 per cent, vitamin A deficiency (six per cent), other vitamin deficiency (15 per cent), disease of teeth and gums (6.4 per cent) and upper respiratory tract infections (6.7 per cent).

Problems related to deficiency of iodine:
1. Damage to brain
2. Low IQ in children with 10 to 15 points lower than the average
3. The deficiency syndrome starts right from the womb and continues to adulthood
4. Causes cretinism, an irreversible form of mental retardation
5. Abortions
6. Still birth
7. Defect in speech and hearing
8. Stiffness in joints and limbs

Problems related to deficiency of iron

1. Tiredness and fatigue
2. Low digestion levels
3. Dullness
4. Low haemoglobin levels (anaemia)
5. Mood changes
6. Decreased cognitive function
7. Poor concentration
8. Light headedness, headaches and ringing in the ears
9. Irritability, pale skin and restless syndrome

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